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Male
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Clinical assessment includes duration of infertility, scrotal and penile development, testicular volume, evidence of androgen deficiency.
Semen analysis - fertility including Sperm Ab.
Sperm function tests (eg, structural abnormalities, oocyte binding) are available in only a few specialised laboratories. Follicle stimulating hormone, Luteinising hormone, Testosterone, Prolactin. Testicular biopsy is rarely indicated (special fixative required).
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Testicular failure
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Hypogonadotrophic hypogonadism (Hypothalamic/pituitary disorders)
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See Pituitary/hypothalamic disorders.
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Gonadotrophin releasing hormone deficiency (Kallmann syndrome)
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See Pituitary/hypothalamic disorders.
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Panhypopituitarism
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See under Hypopituitarism.
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Prolactinoma
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See Pituitary hormone excess.
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Hereditary haemochromatosis
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Hypergonadotrophic hypogonadism (primary testicular disorders)
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Chromosome abnormalities
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Cytogenetics - constitutional.
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Klinefelter syndrome
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Cryptorchidism
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Bilateral anorchia
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Noonan syndrome
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Vanishing testis syndrome
Acquired testicular failure
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Trauma - thermal/physical
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Varicocoele
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Cirrhosis
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Renal failure
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Cytotoxic drugs/irradiation
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Viral orchitis
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Myotonic dystrophy
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Autoimmune
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Iron overload
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Usually eugonadotrophic.
History of Mumps, or other viral infection, associated with Orchitis.
See under Muscular dystrophy.
Sperm Ab.
Iron studies (iron stores).
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Anatomical abnormalities, eg
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Obstruction to vas deferens or epididymis, especially
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Post-vasectomy
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Sexually transmitted diseases
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Congenital bilateral absence of vas deferens especially
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Erectile dysfunction
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Retrograde ejaculation |
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Autoimmune especially
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Sperm Ab.
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Female
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Clinical assessment includes menstrual history and duration of infertility; consider the possibility of infertility in partner - see above. Endometrial biopsy, if indicated, to evaluate the response to endogenous hormones and to exclude infection and neoplastic lesions. See also Amenorrhoea.
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Tubal/uterine disease, especially
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Pelvic inflammatory disease
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Sexually transmitted diseases
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Endometriosis
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Anatomical abnormalities
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Anovulation
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The patient may present with Amenorrhoea or oligomenorrhoea or may have a normal menstrual history; in which case anovulatory cycles may be occurring or the luteal phase may be inadequate. Serial Luteinising hormone and Progesterone assays to detect the absence of a luteinising hormone surge at ovulation or inappropriate luteal Progesterone levels.
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References
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See also Pathology Decision Support Tool: Infertility (female)
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